Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease.
{"title":"Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease.","authors":"Lei-Lei Qu,Wen-Ping Zhao,Ji-Ping Li,Wei Zhang","doi":"10.12998/wjcc.v12.i26.5893","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is often combined with respiratory failure, which increases the patient's morbidity and mortality. Diaphragm ultrasound (DUS) has developed rapidly in the field of critical care in recent years. Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator. Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.\r\n\r\nAIM\r\nTo explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.\r\n\r\nMETHODS\r\nNinety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed, and they were divided into a successful ventilation group (68 cases) and a failed ventilation group (26 cases) according to the outcome of ventilation. The clinical data of patients with successful and failed noninvasive ventilation were compared, and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.\r\n\r\nRESULTS\r\nThere were no significant differences in gender, age, body mass index, complications, systolic pressure, heart rate, mean arterial pressure, respiratory rate, oxygen saturation, partial pressure of oxygen, oxygenation index, or time of inspiration between patients with successful and failed mechanical ventilation (P > 0.05). The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide (PaCO2) than those with failed treatment, while potential of hydrogen (pH), diaphragm thickening fraction (DTF), diaphragm activity, and diaphragm movement time were significantly higher than those with failed treatment (P < 0.05). pH [odds ratio (OR) = 0.005, P < 0.05], PaCO2 (OR = 0.430, P < 0.05), and DTF (OR = 0.570, P < 0.05) were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.\r\n\r\nCONCLUSION\r\nThe DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":null,"pages":null},"PeriodicalIF":1.0000,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Clinical Cases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.12998/wjcc.v12.i26.5893","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
BACKGROUND
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is often combined with respiratory failure, which increases the patient's morbidity and mortality. Diaphragm ultrasound (DUS) has developed rapidly in the field of critical care in recent years. Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator. Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.
AIM
To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.
METHODS
Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed, and they were divided into a successful ventilation group (68 cases) and a failed ventilation group (26 cases) according to the outcome of ventilation. The clinical data of patients with successful and failed noninvasive ventilation were compared, and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.
RESULTS
There were no significant differences in gender, age, body mass index, complications, systolic pressure, heart rate, mean arterial pressure, respiratory rate, oxygen saturation, partial pressure of oxygen, oxygenation index, or time of inspiration between patients with successful and failed mechanical ventilation (P > 0.05). The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide (PaCO2) than those with failed treatment, while potential of hydrogen (pH), diaphragm thickening fraction (DTF), diaphragm activity, and diaphragm movement time were significantly higher than those with failed treatment (P < 0.05). pH [odds ratio (OR) = 0.005, P < 0.05], PaCO2 (OR = 0.430, P < 0.05), and DTF (OR = 0.570, P < 0.05) were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.
CONCLUSION
The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.
背景慢性阻塞性肺疾病(AECOPD)急性加重往往合并呼吸衰竭,从而增加了患者的发病率和死亡率。近年来,膈肌超声(DUS)在重症监护领域发展迅速。通过 DUS 监测膈肌相关的快速浅呼吸指数的研究表明,在指导重症监护室患者脱离呼吸机方面取得了重要成果。目的探讨DUS指标对AECOPD患者无创通气结果的预测价值。方法回顾性分析2022年1月至2023年12月在我院接受机械通气的94例AECOPD患者,根据通气结果分为通气成功组(68例)和通气失败组(26例)。结果机械通气成功与失败患者在性别、年龄、体重指数、并发症、收缩压、心率、平均动脉压、呼吸频率、血氧饱和度、血氧分压、氧合指数、吸气时间等方面均无显著差异(P>0.05)。与治疗失败的患者相比,无创通气成功的患者住院时间更短,二氧化碳分压(PaCO2)更低,而氢电位(pH)、膈肌增厚分数(DTF)、膈肌活动和膈肌运动时间明显高于治疗失败的患者(P < 0.pH值[比值比(OR)=0.005,P<0.05]、PaCO2(OR=0.430,P<0.05)和DTF(OR=0.570,P<0.05)被确定为影响AECOPD患者机械通气结果的独立因素。结论DUS指标DTF可以更好地预测AECOPD患者无创通气的结果。
期刊介绍:
The World Journal of Clinical Cases (WJCC) is a high-quality, peer reviewed, open-access journal. The primary task of WJCC is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of clinical cases. In order to promote productive academic communication, the peer review process for the WJCC is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJCC are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in clinical cases.